Coarctation of the Aorta

What Is Coarctation of the Aorta?

Coarctation of the aorta(COA) is a narrowing
of the aorta, the major blood vessel that carries blood away from the heart
to the body. This narrowing causes the left side of the heart to work harder
to pump blood through the aorta.

Sometimes the coarctation is minor and might not even cause symptoms. Other times,
surgery or other procedures are needed to treat it.

What Causes COA?

Coarctation of the aorta is a congenital defect, meaning that a baby is born with
it. Doctors aren't sure why some people develop COAs, but boys are almost twice as
likely to have it than girls.

In a baby with a coarctation, the aortic arch also might be smaller than usual
(or hypoplastic).

In many people, the defect shows up with other birth defects or conditions, such
as a ventricular septal defect (a hole in the wall
between the heart's left and right ventricles). It's also fairly common in girls born
with Turner syndrome, a genetic disorder in
which one of a girl's two X chromosomes is incomplete or missing.

Usually, COA is found early. But some people aren't diagnosed until they're teens
or even adults. In those cases, it's usually because the narrowing in the aorta is
not severe enough to cause serious symptoms until then. But even people who don't
have major symptoms need treatment because COA can eventually cause problems. The
defect doesn't go away on its own.

What Are the Signs & Symptoms of COA?

Abnormal blood pressure is often the first sign of COA. During a physical exam,
a doctor may find that a child with a coarctation has higher blood pressure in the
arms than in the legs. The doctor also might hear a heart
murmur or notice that the pulse in the groin is weak or hard to feel. Any person
diagnosed with high blood pressure should
be checked for coarctation of the aorta.

Often, kids don't have any symptoms and the COA is discovered during a regular
visit to the doctor. Kids who do have symptoms might have:

cold legs and feet

shortness of breath, especially when exercising

chest pain

How Is Coarctation of the Aorta Diagnosed?

Doctors may refer a child with the signs or symptoms of COA to a pediatric cardiologist
(a doctor who specializes in diagnosing and treating heart problems). The cardiologist
will listen to the heart, feel the pulses, and check blood pressure.

The cardiologist might order an echocardiogram
— a test that uses sound waves to create a picture of the heart and its circulation
— and other tests that produce images of the heart, like a chest
X-ray, a magnetic resonance imaging (MRI) test, or a computerized tomography (CT)
scan.

COA must be treated quickly because it can cause high blood pressure and enlarge
the heart. It also can cause dissection or rupture of the aorta, which can be fatal.
Severe coarctations usually are found shortly after birth and repaired by surgery
immediately.

How Is COA Treated?

Coarctation of the aorta can be repaired with surgery or other procedures. One
of the most common ways to fix a coarctation is to remove the narrow section and reconnect
the two ends of the aorta.

In some cases, doctors may do a balloon dilation (also
called balloon angioplasty). In this procedure, a tiny balloon
is inserted into a blood vessel in the leg and a very thin wire is threaded up to
the aorta, across the narrow area. When the balloon is inflated, the narrow area is
widened. Then the balloon is removed. The cardiologist also may implant a stent
to keep the area open after the procedure.

Looking Ahead

After the defect is fixed, most symptoms of COA disappear right away because the
blockage that caused those symptoms is gone. Some people will still have high blood
pressure for a while and might have to take medicine to control it.

Kids and teens who have had surgery often feel completely better after a week or
two, and those who have had the balloon treatment feel better even sooner, often within
a couple of days.

But doctors recommend that all patients avoid some physical activities —
especially lifting heavy objects or sports that could cause an impact to the chest
— for several weeks or months to give the body enough time to heal. Someone
whose blood pressure remains high may have to continue to limit certain activities
until the blood pressure lowers.

Kids who've had a COA corrected will need to see their doctors regularly. Sometimes,
the narrowing can return after surgery or balloon dilation treatment. Visits to the
cardiologist every year or two after recovery will let the doctor monitor blood pressure
and look for signs that COA could be returning.

If your child has COA or has had a coarctation repaired, call the doctor if you
see shortness of breath, chest pain, or fainting.

Overall, kids who have had coarctation of the aorta can expect to lead a normal
life after treatment.